Wednesday, January 1, 2014

This blog highlights techniques that can be used in therapy with children. These videos are designed by graduate-level social work students (MSW) at the University of North Dakota and are adapted from literature and workbooks. They should be utilized by licensed mental health professionals who are trained to work with children, and used within an appropriate therapeutic context. Practitioners who would like to replicate these exercises should be informed by practice wisdom, agency guidelines, and the evidence-based literature relevant to the intervention and population. This blog is maintained by Melanie Sage, Assistant Professor of Social Work. Please contact me with any comments or questions about this blog. Melanie.Sage@und.edu

Wednesday, July 31, 2013

Evidence based literature supports that relaxation breathing is beneficial for the mental and physical well-being of children and adults. Relaxation breathing techniques are incorporated in several therapy modalities utilized with children who are experiencing problems such as anxiety, depression and issues with anger management. The relaxation technique of deep breathing is used within treatments such as trauma focused cognitive-behavioral therapy and exposure therapy. Deep breathing relaxation is also beneficial for pain management.

Bubble Breaths is a very simple, inexpensive and portable technique; but most of all, it’s fun. While enjoying blowing bubbles and building rapport with the clinician, children can learn about their anatomy and how their bodies and mood can be affected by their breathing.

The intervention I chose to undertake with my cinema star nephew was Click! Emotions. This intervention is designed to assist children with developing emotional intelligence. A practitioner and a child come up with a list of emotions together. Then, the practitioner asks the child to express the emotion using their face, and the practitioner captures the child’s facial expression on a camera. The child then describes to the practitioner the number of times he or she experiences that emotion.

Center on the Social & Emotional Foundations for Early Learning. (2009). Fostering emotional literacy in young children: labeling emotions. Retrieved from http://csefel.vanderbilt.edu/kits/wwbtk21.pdf

Lowenstein, L. (2011). Creative play therapy interventions for children and families. Retrieved from http://www.lianalowenstein.com/article_journals.pdf

Tuesday, July 23, 2013

The intervention that I spoke about in my video assignment was a technique used in Cognitive Behavioral Therapy (CBT). This technique demonstrates how thoughts and feelings impact actions, and that by changing thoughts, it is possible to change behavior. This therapeutic method can be used with children as well as adults, and in groups or working with individuals.

The Fly By Design activity is part of an evidence based curriculum developed by Dr.Harvey Milkman and Dr. Kenneth Wanberg (2005). In this activity, participants make a paper airplane and fly it. The instructor notes how far the plane flies. After this, participants are asked to make a second airplane and are encouraged to modify it. The planes represent thoughts and the distance represents actions taken. Metaphorically, one’s thoughts control one’s actions, just as the plane design controls the distance that the plane travelled. By changing the design (or thoughts), the participant is able to control the plane (or actions).

Friday, May 3, 2013

Lego Therapy is a social skills intervention that motivates children to work together by dividing the tasks into different roles. One child is the Engineer (describing instructions), another child is the supplier (finds the correct pieces), and another child is the builder (puts the pieces together). This intervention showed a reduction in maladaptive behavior and improvement in their socialization and communication. References

Owens, G., Granader,
Y., Humphrey, A., & Baron-Cohen, S. (2008). LEGO ® Therapy and the Social
Use of Language Programme: an evaluation of two social skills interventions for
children with high functioning autism and Asperger syndrome. Journal Of
Autism & Developmental Disorders, 38(10), 1944-1957.
doi:10.1007/s10803-008-0590-6

Sometimes when children have experienced loss, they may not be able to express their feelings. The "Magic Key" can be used to help children become more open about their feelings of loss. This technique can be used to encourage more discussion about the child's feelings of loss. This drawing can help facilitate dialogue to help the healing process.

This
video demonstrates an intervention that can be done with children who suffer
from anxiety. According to a survey conducted by the National Institute of
Mental Health, 8 percent of teenagers ages 13-18 have an anxiety disorder with
the symptoms emerging around age 6. All children experience some anxiety.
Treatment is only necessary if the anxiety becomes severe enough to interfere
with the child’s normal activities.
Interventions can help when children are feeling overwhelmed and make
their anxieties more manageable.

This
intervention is called “All Tangled Up” and the idea of the intervention is to
help the child externalize their worry and to show them that using one of these
strategies can help calm themselves down and eliminating their anxious
feelings. This intervention could be done by a social worker or the child’s
parents.

Summary: When working with adolescent clients it can sometimes be a challenge for that client to feel comfortable opening up about their feelings and emotions. One simple intervention that can be utilized is creating an It's My Life CD. This activity helps create a starting point for conversation and can be a tool for future discussions.

The client will create their own CD (Title, Cover Design, Song List, etc) and can be very vague related to any part of their life, or more specific relating to treatment issues.

The video briefly
explains a simple activity for a therapist to use with a child to increase the
child's awareness of people that love, care about, and help them. The activity
is called "You're A Star" and can also be used as a method of coping
with future emotional issues that the child may encounter.

This is an activity that is described in more detail in Liana Lowenstein's
"Favorite Therapeutic Activities for Children, Adolescents, and Families:
Practitioners Share Their Most Effective Interventions" which can be
accessed at:

It can be challenging to
engage children in initial therapy sessions. Colored Candy Go Around is a
creative way to gather information about the client and their family and begin
to open up communication as well as identify goals for therapy. This is an
activity can also be used to engage children during initial group sessions.
Questions can be easily modified to fit each family or group situation.

Play therapy has been proven to be an effective intervention when
working with children facing stressors in their life (Cochran, Cochran, Fuss,
and Nordling, 2010). Play
therapy creates a non-threatening environment where a child is able to engage
in self-expression (Cochran et al., 2010). Often times, when children present
themselves for therapy they are initially unwilling to share directly their
thoughts and feelings (Lowenstein, 2011). However, the use of play therapy can
break down this reluctance and create an outlet for the child to express his or
her feelings and emotions (Lowenstein, 2010). Therapists who effectively use play
therapy can have very productive sessions with children. One play therapy intervention that is
particularly effective is an activity named “Butterflies in My Stomach”
(Lowenstein, 2011).

Therapeutic
techniques that engage all family members can be difficult to find and use in
family therapy sessions. The First Session Family Card Game is designed to
engage the entire family in the therapeutic process and in communicating with
each other.

This
game allows for questions that can be used to understand and observe the
dynamics of the family present in therapy which can later be helpful in
treatment planning. The questions are created with the purpose of family
joining in mind. They also are helpful in allowing families to realize what
their goals for treatment consist of. The First Session Family Card Game also
includes opportunities for positive interactions between family members such as
hugs and small treats further help to engage family members in the therapeutic
process.

The First Session Family Card Game can be modified to fit
other situations as well. For instance, the questions can be adapted so that
the game could be used in a family’s last session of therapy. These questions
would focus on the gains the family achieved through the therapeutic process,
as well as, what they learned from their sessions and what the therapist
learned from them. The game and questions can also be modified to fit specific
target populations such as children for children who are experiencing loss or grief.

Chasin, R., & White, T. B. (1989). The
child in family therapy: Guidelines for active engagement across the age span.

Sunday, August 5, 2012

Social dysfunction or "awkwardness" is often associated with Autism Spectrum Disorders. Early intervention has been found to be effective with children diagnosed with ASD, although it is not a curable disorder. Early interventions can include a variety of strategies, but Visual Interventions, such as Social Stories, Social Scripts, Power Card Strategy and 5 Point scales have proven to be most effective in home, school and community setting with ASD children. Implementation of these skills increase self and social awareness and a competence in social situations.

Feelings
Hide and Seek – provides a safe environment for clients to verbalize and
discuss their feelings; increase open communication regarding various emotional
states; and strengthens family relationship through direct communication.

Tuesday, July 31, 2012

This Behavior Modification strategy enables the
child to know the expectations for his/her behavior and helps you to maintain
consistent positive/negative reinforcement.

Short,
Soft and Close: Delivering Effective Reprimands

There are three key parts of an effective reprimand;
short, soft, and close. When used
correctly, reprimands can serve to alter behavior without encountering an angry
confrontation.

• Short—The reprimand should consist of
the child’s name and one or two additional

words of direction such as, “Mike,
stop yelling.”

• Soft—The reprimand should be audible
only to the child. This serves to keep
the

adults’ emotions in check and helps to
lower the dynamic of the confrontation.

• Close—The reprimand should be delivered
from within a few feet of the child,

preferably within reach of the
child. A soft touch on the arm or
shoulder will prove

to make the reprimand much more
effective than will shouting it from the next

room.
The child will have your full attention and will be more likely to stop
the

targeted behavior.

Finally, after the reprimand is delivered and the
targeted behavior has stopped, try to catch the child doing something good
within the next few minutes. Praise
him/her for positive behavior in order to reinforce desired, appropriate
behavior.

Working with children produces greater effects when
we build on the positives and not the negatives. Children are eager to please, yet adults
often only point out when a child has misbehaved. Children with ODD are used to hearing about
all of their negative characteristics.
By creating as many opportunities for positive reinforcement as
possible, we set up ways for the child to experience the positive feelings
associated with cooperation and praise. As
a general rule, each day children should hear more positive than negative
comments about themselves.

The
problem solving hand is a simple technique that can be used by children to use
in conflict situations. Problem solving techniques are incorporated and
supported in many evidence based practices when working with children. In
the schools it addresses academic and behavioral problems by utilizing problem
solving. Schools also incorporate problem solving interventions within
their social emotional curricula. An example where problem solving
is core to its evidence based intervention is the RTI (Response to
Intervention) curriculum. Click on the link below demonstrating the use
of the problem solving hand.

The SASSI-A2 was developed by Dr. Glenn A. Miller. The original adult version of the SASSI was
published in 1988 and quickly became one of the most widely used substance
abuse screening instruments. The
SASSI-A2 was published in 1994 and became just as popular for screening clients
twelve to eighteen years of age. The
SASSI-A2 boasts a 94% instrument accuracy.
However, it is not intended to prove a substance disorder diagnosis, but
to be single component of a comprehensive screening process. The self-report questionnaire takes
approximately fifteen minutes to complete, and can be administered by any human
service worker trained in proper administration procedures.

This in an intervention
I use with my clients to help them open up (a lot of them are anxious and won't
talk), particularly in groups to facilitate discussion. Because about 99% of my
clients have some type of anxiety disorder, we normally use CBT to treat it,
and this intervention allows them to feel comfortable opening up and talking
about their feelings. It also helps gather information about the client that
they may not have normally told you (without the game).

The
Maudsley Approach is applied to adolescents 18 and under who are living with
their families. It is designed to
intervene aggressively in the first stages of illness and is a short term model
as short as 20 sessions or six months in duration.

The
Maudsley Approach builds on evidence that family therapy approaches are
superior to individual therapy approaches with younger patients. This approach involves the family from the
outset of treatment and relies heavily on patient involvement in the re-feeding
of the child with an eating disorder.

Parents
are empowered to help their adolescent recover from this life threatening
illness, rather than having them watch passively from the sidelines. This treatment involves compassion, yet
persistent and firm expectations that your adolescent eat an amount of food
that can reverse the state of starvation his or her body is in and help them to
gain weight.

In the
first stage of treatment, the therapist plays an active and key role in helping
parents separate their child from the child’s illness. Parents are given the task of re-feeding and
removing the illness from the child.

Re-feeding the patient begins as
the patient usually has just been hospitalized and is medically compromised. This phase focuses exclusively on the re-feeding
of the patient and other psychological issues are not explored. Parents are encouraged to set their own goals
regarding their child’s weight and health, with the emphasis on physical
appearance and menstruation in girls as an indicator rather than precise weight
goals.

Stop,
Watch, and Copy is a modeling technique that can be used with any child, but is
particularly useful with children who have a diagnosis of autism or asperger’s
syndrome. Children with autism or
asperger’s often tend to miss social cues which result in them not being able
to exhibit appropriate behaviors in social situations. Not being able to act appropriately in social
situations creates added stress in the life of a child who already is dealing
with the symptoms related to the autism or Aspergers syndrome.

To
implement Stop, Watch, and Copy, you can use visual cue cards (like the one’s
below) or verbally talk with the child about stopping when they enter a social situation, watching what is going on around them, and then copy the behaviors (positive) that they
see other people doing. It is important
that the child can identify the difference between positive and negative
behaviors so that they do not copy the negative behaviors that may be
occurring.

Depression will affect between 3-8 percent of the
population by mid-adolescence. Research supports CBT to be used with
significant success with mild to moderate depression. The National
Institute of Mental Health has found that when treating major depression in
adolescents with medication, CBT not only aids in a faster recovery, but also
provides additional safeguards for those vulnerable to suicide.

CBT gives the adolescent a way of better
understanding how their negative thoughts affect how they respond to different situations,
and in turn, how they feel. With the use of specific tools to change
negative thoughts, youth are able to work their way out of depression.
One of the goals of CBT is cognitive restructuring which asks the client to
identify his or her negative, unrealistic or unhelpful thoughts, evaluate
evidence for and against these, and generate a more positive, realistic or
helpful thought based on this evidence”

This video gives one example of a CBT tool that can
be used to aid in cognitive restructuring.

The video demonstrates the use of drawing "Face
Circles" and "Family Circles" in order to conduct a
developmental assessment of a child while also building rapport. Completing a developmental assessment allows
an interviewer to later tailor questions to a particular child's competence and
overall functioning, including motor skills, language, and cognitive
skills. This will aide in collecting the
most reliable information from the child during later interviews.

Drawings can assist in building rapport with a child
because drawing, typically, is an engaging activity and is an appropriate tool
of communication with all ages of children.

The video also demonstrates the skill of inviting
narrative from the child while both are engaged in drawing. This allows the child to practice answering
in narrative form while discussing neutral or positive topics.

Monday, April 23, 2012

As many as 3-9% of school aged children in the
United States suffer from ADHD. The use
of an ADHD rating scale can help practitioners with the diagnosis for ADHD. An ADHD rating scale can be filled out by any
two different people who see the child on a regular basis in two different
settings. Most popular choices are
parents and teachers. There are a number
of ADHD rating scales available; this is an example of one of them.

by Kristin Petersen

References:

Supporting the use of an ADHD rating scale are the following
resources:

Saturday, April 21, 2012

Children seen in a mental
health setting have an estimated occurrence of anxiety between 12-20% (Carter,
2010). Often feelings of anxiety and its concurrent physical
discomfort can cause feelings of fear and confusion which may cause
children to have avoidant or distracting responses.

The therapeutic treatment in relation to
anxiety in children and having primary efficacy is Cognitive Behavioral Therapy
(CBT). In the preliminary phase of CBT treatment, psycho-education, the
clinician can assist the child to identify their body’s signals when
anxious. By being able to focus on their body’s responses to anxiety
(e.g., which signals are the strongest and most noticeable) they become more
self-aware and able to promptly use calming or relaxation techniques.

Friday, April 20, 2012

Studies have found that some children may engage in Pica behaviors, because they receive an oral stimulation from the texture of the inedible item. The use of a Pica Box follows this theory and attempts to replace inedible items with items that are edible, but have the same texture as the inedible item. The video will demonstrate how to use a Pica Box to help reduce Pica behavior in children. It will give examples of edible items that can be exchanged for inedible items and it will also give examples of verbal cues that can be used when intervening with the Pica behavior.

The linked articles below provide more information and research on the concept of exchanging edible items for inedible items to help reduce Pica behavior.